Project Description: Farm workers are in one of the three most dangerous occupations in the United States. Previously Dr. Rickie Langley and I conducted a descriptive study of unintentional farm fatalities (n = 393) using medical examiner reports and death certificates to identify deaths due to agricultural occupational injuries in North Carolina from 1984 through 1988 (n = 123). The aim of this study was to use an existing database to achieve maximum accuracy in identifying true cases of work-related farm fatalities. The conceptual framework was the traditional epidemiological model of the interaction among the host, agent and environment. The results found in this study were presented

“Agricultural Hazards and Farming Deaths in North Carolina;” Family Practice Grand Rounds, School of Medicine, East Carolina University; Greenville, North Carolina; December 2, 1993.

“Agricultural Health and Safety -An Overview of Major Concerns of North Carolina Farmers;" North Carolina Association of Occupational Health Nurses' Fall Conference; Greenville, North Carolina; October 7, 1993.

“Tractor Deaths in North Carolina from 1979-88;” American Public Health Association Annual Meeting; Atlanta, Georgia; November 12, 1991.

“Accidental Occupational Farn1 Fatalities in North Carolina;” 14th Annual National Conference of the National Rural Health Association; Seattle, Washington; May 19, 1991.

Unintentional injuries are the leading cause of death for all people ages one through 34 years. The initial fatal farm injury database was expanded to examine farm deaths in children and adolescents under the age of 19 years. Farm children live at increased risk of injury and death because of their unique environment where the home, the playground, and the workplace are the same place. This study found that 181 youths were killed between 1976 and 1988 on farms in North Carolina. Results were analyzed and findings recorded.

In the initial study of fatal farm injuries, tractors were found to be the leading cause of occupational farm fatalities. An elaboration and expansion of the first study identified 342 tractor related fatalities occurring in North Carolina from 1979 through 1988. The characteristics of the host, agent, and the environment were described for each of these fatal events. The aim was to provide the descriptive information needed to design injury prevention programs to prevent tractor related deaths. Slightly over half of the victims (54%) were full- or part-time farmers in the act of farming at the times of their deaths. This study was presented

Another study looked in-depth at the tractor related deaths from 1979-1988 when the victim had a measurable blood alcohol concentration (HAC) at the time of injury (n = 50). Nineteen percent of tested victims had a detectable HAC ranging from 20 to 390 mg/dL. All of these deaths are potentially preventable. The results of this study were presented at an annual meeting of the American Public Health Association.

The purpose of this grant request is to seek funding to collect and analyze the same types of data on farm-related deaths for the 14-year period from 1989 through 2002. The general research design and operational definitions developed and used in the earlier studies will be used for this project. Whenever possible, comparisons will be made between the more recent fatalities and those described in earlier years. This would include data on all farm-related deaths, all tractor deaths, childhood farm deaths and BAC related tractor deaths.

Before interventions can be developed to prevent fatal injuries occurring on farms, the descriptive database must be expanded. While there is some knowledge about the characteristics of the person who died, very little is known about the characteristics of the agents that caused their death (in particular the tractor, including attachments), or about the environment in which they died. If the number of fatal farm injuries is to be significantly reduced, the full range of injury prevention strategies will be needed. Training and education of farm workers and their families are necessary but not sufficient. Further data is needed regarding so that prevention strategies utilizing protective devices and engineering controls, as well as equipment redesign, may be used. A multi-faceted approach involving the farm family, the equipment used on the farm, and the farm environment is required.

In addition, the large number of tractor-related deaths in those classified as nonfarmers needs to be addressed. While a small number of these deaths were occupational, many were rural citizens using the tractor on their land for non-occupational reasons. Prevention of these deaths will most likely require strategies very different from those used to prevent tractor deaths in farmers and other workers; the target population is different.